RESUMEN
Background: Bleeding is a serious cause of hypotension and tachycardia after childbirth and should always be considered. Case presentation: A healthy woman in her thirties who had previously undergone caesarean section, underwent induction and operative vaginal delivery. Postpartum, she experienced chest pain, hypotension and tachycardia, and had signs of ischaemia on electrocardiogram. A CT scan showed a large intraperitoneal haematoma. The patient underwent immediate laparotomy and received a massive blood transfusion. However, no large haematoma was found. The chest pain was attributed to a myocardial infarction caused by hypovolaemic shock. After discharge, the patient experienced significant vaginal bleeding and was transferred to a different university hospital. A CT scan revealed a large retroperitoneal haematoma. Emergency surgery was performed based on the suspicion of active bleeding, but only an older haematoma was found. Re-evaluation of the initial CT scan revealed that the haematoma was in fact located retroperitoneally and was thereby not found in the first operation. Interpretation: This case highlights the importance of bleeding as an important cause in unstable postpartum patients. Additionally, it is a reminder that retroperitoneal haematomas can occur in obstetric patients and can mask typical symptoms of uterine rupture such as abdominal pain. also hindering perioperative diagnosis.
Asunto(s)
Dolor en el Pecho , Hematoma , Choque , Humanos , Femenino , Adulto , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/diagnóstico , Dolor en el Pecho/etiología , Choque/etiología , Choque/diagnóstico , Tomografía Computarizada por Rayos X , Embarazo , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/diagnóstico por imagen , Espacio Retroperitoneal/diagnóstico por imagen , Cesárea/efectos adversos , Electrocardiografía , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Hemorragia Posparto/etiología , Hemorragia Posparto/diagnósticoRESUMEN
OBJECTIVE: Puerperal uterine inversion is a rare and severe complication and is associated with short cord, uncontrolled cord traction, placenta accreta, or uterine atony. CASE REPORT: A primigravida woman gave birth a 2770 gm newborn at term at our hospital, and clinically presented postpartum hemorrhage, hypovolemic shock, postpartum preeclampsia and urinary retention. She discharged 3 days postpartum, but she complained persist vaginal bleeding and lower abdominal pain for more than 1 month. Uterine inversion was diagnosed and laparoscope surgery for reduction was done. CONCLUSION: The non-specific clinical presentation made diagnosis of uterine inversion more difficult. Except pelvic examination, sonographic and hysteroscopic images were record in this article. Surgical intervention was performed. A fundus incision was effective for reduction and had low risk of bladder and bowel injury.
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Trastornos Puerperales , Inversión Uterina , Humanos , Femenino , Inversión Uterina/etiología , Inversión Uterina/cirugía , Adulto , Embarazo , Trastornos Puerperales/cirugía , Trastornos Puerperales/etiología , Trastornos Puerperales/diagnóstico , Hemorragia Posparto/etiología , Hemorragia Posparto/cirugía , Enfermedad CrónicaRESUMEN
OBJECTIVE: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of of peripartum cardiomyopathy (PPCM) in the internal medicine department of the Zinder National Hospital (ZNH). METHODS: This was a descriptive cross-sectional study carried out from 2018 to 2022 at the ZNH Department of Internal Medicine. Included were all patients admitted for PPCM who met National Heart Blood and Lung Institute criteria. The data collected was analyzed using Excel and EPI INFO v7. RESULTS: We had collected 100 cases of PPCM out of a total of 8706 hospitalized patients, i.e. a hospital prevalence of 1.14%. The mean age of the patients was 27.9 years ± 7.4 [17-45]. The majority of patients were from underprivileged social strata (n=64). The risk factors for PMPC found were essentially hot bath (n=66), home birth (n=40), natron porridge (n=35) and multiparity (n=57). Cardiac symptomatology appeared postpartum in 56% of patients. Dyspnea was the main symptom in 98% of cases. The physical signs were dominated by the functional systolic murmur (66%). Three quarters (75%) of the patients had congestive heart failure. Electrocardiographic signs were dominated by left ventricular hypertrophy (n=65). Cardiomegaly was present in 94% of patients. Left ventricular ejection fraction was altered in all patients. Impaired renal function was found in 31% of patients. Management was based on a low-sodium diet tripod, diuretics and converting enzyme inhibitors. Two cases of death were recorded. CONCLUSION: PPCM is common in the Zinder region. It affects young women with several risk factors and is revealed by signs of congestive heart failure. For a better understanding of this still poorly elucidated condition, it is necessary to pursue research efforts.
Asunto(s)
Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Adulto , Estudios Transversales , Embarazo , Cardiomiopatías/epidemiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/etiología , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Persona de Mediana Edad , Adolescente , Niger/epidemiología , Factores de Riesgo , Prevalencia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Recursos en Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome. METHODS: This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR. RESULTS: This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123-0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289-6.552, p = 0.011). CONCLUSIONS: Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.
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Analgesia Epidural , Analgesia Obstétrica , Analgésicos Opioides , Anestesia Epidural , Retención Urinaria , Humanos , Retención Urinaria/etiología , Femenino , Analgésicos Opioides/administración & dosificación , Embarazo , Estudios Retrospectivos , Estudios de Casos y Controles , Adulto , Factores de Riesgo , Trastornos Puerperales/etiologíaRESUMEN
INTRODUCTION AND HYPOTHESIS: The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women. METHODS: A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45 years, and gestational age ≥ 37 weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2 days, 6 weeks, 3 months, and 6 months. Multivariate logistic regression was used to analyze risk factors for UI. RESULTS: The incidence of self-reported UI at 2 days, 6 weeks, 3 months, and 6 months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL. CONCLUSION: In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6 weeks and all resolved at 6 months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.
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Calidad de Vida , Incontinencia Urinaria , Humanos , Femenino , Adulto , Estudios Prospectivos , Incidencia , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/etiología , Factores de Riesgo , Adulto Joven , Embarazo , Periodo Posparto , Cafeína/efectos adversos , India/epidemiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Adolescente , Persona de Mediana EdadRESUMEN
BACKGROUND: Postpartum urinary retention is a common complication following caesarean section, with significant implications for patient comfort and recovery. Combined spinal and epidural anaesthesia is frequently employed for caesarean section, but postpartum urinary retention remains a clinical concern despite its benefits. This study aimed to investigate the effectiveness of hydromorphone hydrochloride combined with bupivacaine for combined spinal and epidural anaesthesia in reducing postpartum urinary retention. METHODS: A retrospective analysis was conducted on patients who received combined spinal and epidural anaesthesia for caesarean section. The control group received bupivacaine, whereas the hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia (HB) group received hydromorphone hydrochloride combined with bupivacaine. Data on demographics, anaesthesia, operative characteristics, postoperative urinary retention and adverse events were collected and analysed. RESULTS: The study enrolled 105 patients, with a control group (n = 51) receiving bupivacaine spinal-epidural anaesthesia and an observation group (n = 54) receiving hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia. The incidence of postoperative urinary retention was significantly lower in the HB group than in the control group (3.70% vs. 17.65%, p = 0.044). Furthermore, the HB group exhibited a shorter time to first voiding after anaesthesia (5.72 ± 1.26 h vs. 6.28 ± 1.35 h, p = 0.029), lower peak postvoid residual volume (168.57 ± 25.09 mL vs. 180.43 ± 30.21 mL, p = 0.032), decreased need for postoperative catheterisation (5.56% vs. 21.57%, p = 0.034) and shorter duration of urinary catheterisation (10.92 ± 2.61 h vs. 12.04 ± 2.87 h, p = 0.039) than the control group. Correlation analysis supported a negative correlation between hydromorphone supplementation and parameters related to postoperative urinary retention. Multivariate regression analysis demonstrated a significant association between the duration of urinary catheterisation and the use of hydromorphone with the occurrence of postoperative urinary retention, providing further insights into the multifactorial nature of this postoperative complication. CONCLUSIONS: The addition of hydromorphone hydrochloride to bupivacaine for combined spinal and epidural anaesthesia was associated with a reduced incidence of postpartum urinary retention and improved postoperative voiding parameters, without significantly increasing the risk of adverse events.
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Anestesia Epidural , Anestesia Raquidea , Bupivacaína , Hidromorfona , Retención Urinaria , Humanos , Retención Urinaria/prevención & control , Retención Urinaria/etiología , Hidromorfona/administración & dosificación , Hidromorfona/uso terapéutico , Hidromorfona/efectos adversos , Estudios Retrospectivos , Femenino , Anestesia Raquidea/efectos adversos , Bupivacaína/administración & dosificación , Adulto , Anestésicos Locales/administración & dosificación , Cesárea/efectos adversos , Anestesia Obstétrica/efectos adversos , Anestesia Obstétrica/métodos , Embarazo , Trastornos Puerperales/prevención & control , Trastornos Puerperales/etiología , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Resultado del TratamientoAsunto(s)
Dolor Abdominal , Fiebre , Trastornos Puerperales , Úlcera Cutánea , Síndrome de Sweet , Adulto , Femenino , Humanos , Dolor Abdominal/etiología , Diagnóstico Diferencial , Fiebre/etiología , Periodo Posparto , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/patología , Trastornos Puerperales/terapia , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/etiología , Síndrome de Sweet/patología , Síndrome de Sweet/terapia , Supuración/diagnóstico por imagen , Supuración/terapia , Drenaje , Antibacterianos/uso terapéutico , Glucocorticoides/uso terapéuticoRESUMEN
BACKGROUND: Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM. METHODS: Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies. RESULTS: PPCM was associated with a greater than 4-fold increased risk of pregnancy-related stroke (aHR 4.7, 95% CI: 3.0-7.5). This risk was highest at the time of PPCM diagnosis but remained elevated in the first postpartum year. CONCLUSION: Our findings confirm the strong association between PPCM and stroke, with risk that persists throughout and after the peripartum period.
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Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Accidente Cerebrovascular , Humanos , Femenino , Embarazo , Incidencia , Adulto , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Cardiomiopatías/epidemiología , Cardiomiopatías/fisiopatología , Volumen Sistólico/fisiología , Factores de Riesgo , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Estudios RetrospectivosAsunto(s)
Glucemia , Diabetes Gestacional , Periodo Posparto , Humanos , Femenino , Diabetes Gestacional/sangre , Embarazo , Glucemia/metabolismo , Glucemia/análisis , Medición de Riesgo , Adulto , Prueba de Tolerancia a la Glucosa , Factores de Riesgo Cardiometabólico , Trastornos Puerperales/sangre , Trastornos Puerperales/etiologíaRESUMEN
INTRODUCTION AND HYPOTHESIS: Catheterization is a common treatment for postpartum urinary retention (PUR); however, its application before diagnosis of PUR remains unclear. The aim was to give an overview of the existing literature on the effectiveness and safety of intrapartum or postpartum catheterization in the prevention of PUR. METHODS: This scoping review followed a methodological framework. PubMed, the Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure, WanFang, the China Science and Technology Journal Database, and the China Biomedical Literature Database were searched from the inception of each database to 21 May 2023. RESULTS: The search revealed 16 studies examining three different catheterization methodologies, including 12 intrapartum studies. Ten studies concluded that intrapartum or postpartum catheterization prevented PUR, two of which were only for overt or covert PUR. In 4 out of 13 experimental studies, no significant difference was found: one for intrapartum catheterization versus routine nursing, the other for intrapartum or postpartum intermittent versus indwelling catheterization. However, one found that postpartum disposable catheterization after ineffective targeted care reduced the incidence of PUR compared with indwelling catheterization. One out of the 3 case-control studies concluded that prenatal catheterization ≥2 times was a risk factor for PUR. CONCLUSIONS: Based on the findings in this scoping review, catheterization prior to the diagnosis of PUR appears to play a role in preventing PUR and is safe. Preliminary evidence is accumulating on the effectiveness of three types of catheterization methods in preventing PUR, but more comprehensive studies are needed to establish these findings.
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Cateterismo Urinario , Retención Urinaria , Humanos , Femenino , Retención Urinaria/prevención & control , Retención Urinaria/etiología , Retención Urinaria/terapia , Cateterismo Urinario/efectos adversos , Embarazo , Trastornos Puerperales/prevención & control , Trastornos Puerperales/etiología , Periodo PospartoRESUMEN
BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, pâ¯=â¯0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, pâ¯=â¯0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, pâ¯=â¯0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, pâ¯=â¯0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, pâ¯=â¯0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, pâ¯=â¯0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
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Cardiopatías , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Adulto , Estudios Transversales , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto Joven , Adolescente , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Recién Nacido , Edema Pulmonar/epidemiología , Edema Pulmonar/etiología , Periodo PospartoRESUMEN
BACKGROUND AND AIMS: Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-risk AMVP who developed malignant VA during the perinatal period and to assess if pregnancy and the postpartum period were associated with a higher risk of malignant VA. METHODS: This retrospective international multi-centre case series included high-risk women with AMVP who experienced malignant VA and at least one pregnancy. Malignant VA included ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter defibrillator. The authors compared the incidence of malignant VA in non-pregnant periods and perinatal period; the latter defined as occurring during pregnancy and within 6 months after delivery. RESULTS: The authors included 18 women with AMVP from 11 centres. During 7.5 (interquartile range 5.8-16.6) years of follow-up, 37 malignant VAs occurred, of which 18 were pregnancy related occurring in 13 (72%) unique patients. Pregnancy and 6 months after delivery showed increased incidence rate of malignant VA compared to the non-pregnancy period (univariate incidence rate ratio 2.66, 95% confidence interval 1.23-5.76). CONCLUSIONS: The perinatal period could impose increased risk of malignant VA in women with high-risk AMVP. The data may provide general guidance for pre-conception counselling and for nuanced shared decision-making between patients and clinicians.
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Prolapso de la Válvula Mitral , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Embarazo , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/epidemiología , Estudios Retrospectivos , Adulto , Complicaciones Cardiovasculares del Embarazo/epidemiología , Factores de Riesgo , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Taquicardia Ventricular/epidemiología , Taquicardia Ventricular/etiología , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Desfibriladores Implantables , Incidencia , Fibrilación Ventricular/epidemiología , Fibrilación Ventricular/etiología , Periodo PospartoAsunto(s)
Diabetes Gestacional , Hipertensión , Femenino , Humanos , Embarazo , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Diabetes Gestacional/epidemiología , Diabetes Gestacional/fisiopatología , Hipertensión/fisiopatología , Hipertensión/epidemiología , Periodo Posparto , Trastornos Puerperales/fisiopatología , Trastornos Puerperales/etiología , Trastornos Puerperales/epidemiología , Salud de la MujerRESUMEN
INTRODUCTION: While the exact pathogenesis of peripartum cardiomyopathy, a potentially life-threatening condition, is still unknown, its incidence is rising globally. We sought to understand the differences in outcomes and complications based on age. METHODS: Records from the 2016-2020 National Inpatient Sample were used for our study. The sample consisted of females diagnosed with peripartum cardiomyopathy that required hospitalization care. They were divided into two age-based cohorts: 15-29 years and 30-40 years. We evaluated differences in in-hospital complications between the two groups using multivariable regression. RESULTS: The analysis consisted of 20520 females diagnosed with peripartum cardiomyopathy, of whom 57.3 % were in the 30-40 years cohort and 42.7 % in the 15-29 years group. The prevalence of cardiovascular risk factors such as smoking, obesity, hypertension, diabetes and lipid disorder was higher among women aged 30-40 years (p < 0.01). These patients also demonstrated higher odds of reporting acute ischemic stroke (aOR 1.354, 95 % CI 1.038-1.767, p = 0.026) while having a reduced risk of cardiogenic shock (aOR 0.787, 95 % CI 0.688-0.901, p < 0.01) as compared to those aged 15-29 years during their hospitalisation with PPCM. No statistically significant differences were noted for events of acute kidney injury (aOR 1.074, 95 % CI 0.976-1.182, p = 0.143), acute pulmonary oedema (aOR 1.147, 95 % CI 0.988-1.332, p = 0.071) or in-hospital mortality (aOR 0.978, 95 % CI 0.742-1.290, p = 0.877). CONCLUSION: Peripartum cardiomyopathy is a serious condition that requires appropriate care and management. Our study linked cases of ages 30-40 years with increased odds of acute ischemic stroke but lower odds of cardiogenic shock.
Asunto(s)
Cardiomiopatías , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Adulto , Adolescente , Embarazo , Cardiomiopatías/epidemiología , Adulto Joven , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia , Factores de Riesgo , Estados Unidos/epidemiología , Factores de Edad , Estudios Retrospectivos , Incidencia , Hospitalización/estadística & datos numéricos , Prevalencia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Trastornos Puerperales/terapia , Mortalidad Hospitalaria/tendencias , Choque Cardiogénico/epidemiología , Choque Cardiogénico/etiología , Choque Cardiogénico/terapiaRESUMEN
This case report examines peripartum cardiomyopathy (PPCM), a rare variant of heart failure with reduced ejection fraction, which manifests at the end of labor or puerperium. The frequency of this pathology varies globally, and its association with risk factors such as genetic disorders, autoimmune diseases, viral infections, suggests a multifactorial etiology. Diagnostic criteria include: Heart failure secondary to left ventricular systolic dysfunction, manifested in the puerperium or at the end of pregnancy and lack of other identifiable causes of heart failure. The case presents a patient with no significant personal pathological history, who, 17 days post cesarean section developed acute symptoms, including abdominal pain, dry cough and dyspnea. Clinical findings revealed hypoxemia, alterations in blood tests and an echocardiogram that confirmed an atrial septal defect. Multidisciplinary management resulted in successful treatment and the patient was discharged without complications. This case highlights the importance of MCPP, a disease with high maternal mortality. The connection between atrial septal defect and PPCM, as well as the involvement of pulmonary thromboembolism.
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Insuficiencia Cardíaca , Defectos del Tabique Interatrial , Trastornos Puerperales , Embolia Pulmonar , Humanos , Femenino , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico , Embolia Pulmonar/complicaciones , Embolia Pulmonar/etiología , Embolia Pulmonar/terapia , Embarazo , Insuficiencia Cardíaca/etiología , Adulto , Trastornos Puerperales/etiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/terapia , Cardiomiopatías/etiología , Cardiomiopatías/terapia , Cardiomiopatías/diagnóstico , Cardiomiopatías/complicaciones , Periodo Periparto , Complicaciones Cardiovasculares del Embarazo/terapia , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/fisiopatología , CesáreaRESUMEN
RATIONALE: Peripartum cardiomyopathy (PPCM) occurring in the context of hypertension presents a unique clinical challenge. This case contributes to the medical literature by highlighting the complexities of managing heart failure in postpartum women with pre-existing hypertensive disorders, particularly when complicated by a history of preeclampsia. PATIENT CONCERNS: Mrs. O.O., a 34-year-old hypertensive woman, presented with progressive dyspnea, bilateral leg swelling, and orthopnea. Notably, she had a history of previous preeclampsia and exhibited worsening symptoms over several months. DIAGNOSES: The patient was diagnosed with decompensated heart failure secondary to PPCM, exacerbated by hypertension and anemia. INTERVENTIONS: Therapeutic interventions included diuretics, angiotensin receptor-neprilysin inhibitors, digoxin, and anticoagulation. Additionally, lifestyle modifications and dietary restrictions were implemented. OUTCOMES: Following treatment adjustments, the patient demonstrated significant improvement in symptoms, exercise tolerance, and cardiac function. The transition from NYHA class III to class II heart failure indicated successful management. LESSONS: This case underscores the importance of a comprehensive approach to managing PPCM in hypertensive patients, with attention to cardiovascular and obstetric factors. It highlights the effectiveness of multidisciplinary care in achieving positive outcomes and emphasizes the need for heightened vigilance in postpartum women with cardiovascular risk factors.
Asunto(s)
Cardiomiopatías , Insuficiencia Cardíaca , Hipertensión , Preeclampsia , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Embarazo , Humanos , Femenino , Adulto , Periodo Periparto , Cardiomiopatías/complicaciones , Cardiomiopatías/terapia , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/terapia , Hipertensión/complicaciones , Complicaciones Cardiovasculares del Embarazo/terapiaRESUMEN
OBJECTIVES: The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes. METHODS: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data. RESULTS: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower. CONCLUSIONS: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.
Asunto(s)
Hematoma , Hemorragia Posparto , Humanos , Femenino , Estudios Retrospectivos , Hematoma/epidemiología , Hematoma/etiología , Hematoma/terapia , Embarazo , Adulto , China/epidemiología , Factores de Riesgo , Hemorragia Posparto/terapia , Hemorragia Posparto/epidemiología , Centros de Atención Terciaria , Episiotomía/efectos adversos , Episiotomía/estadística & datos numéricos , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/terapia , Estudios de Casos y Controles , Trastornos Puerperales/terapia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiologíaRESUMEN
PURPOSE OF REVIEW: Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS: Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY: Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.
Asunto(s)
Anemia Ferropénica , Humanos , Femenino , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/terapia , Anemia Ferropénica/etiología , Embarazo , Anemia/terapia , Anemia/diagnóstico , Anemia/etiología , Hierro/uso terapéutico , Hierro/administración & dosificación , Periodo Posparto , Trastornos Puerperales/terapia , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Suplementos Dietéticos , Deficiencias de Hierro/diagnóstico , Deficiencias de Hierro/terapiaRESUMEN
Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.